KNEE

Here’s a quick anatomy lesson: put your hand on your knee. Feel that hard piece of bone you call the kneecap? That’s your patella. Patellar tendonitis, commonly known as jumper’s knee, is a painful condition affecting the patella and the surrounding tissue that keeps it in place, called the patellar tendon. Activities such as walking, running and, as the name suggests, jumping, can all put stress on the patellar tendon, resulting in tiny, painful tears and inflammation.

Symptoms of patellar tendonitis include pain, tenderness and sometimes swelling in and around the knee. Discomfort can occur anywhere in the knee, but it’s most common just below the patella, where the patellar tendon connects to the tibia (shinbone). Those with patellar tendonitis often complain of pain when bending or straightening their leg, as well as a dull ache behind the knee joint.

Given that physical activity usually causes patellar tendonitis, it’s no surprise that athletes are most commonly affected. However, even people that lead more sedentary lives can have the condition. Factors like muscular imbalance and poor foot structure are among the many possible causes, as they both affect the position of the patella.

If you have patellar tendonitis, a variety of safe and effective techniques can help. Rehabilitative exercise is just one of the options your healthcare practitioner has for reducing your pain and improving your condition.

Lateral collateral ligament (LCL) sprains are rare. Most commonly, these injuries occur when something hits the inside of your knee while your foot is on the ground. Imagine, for example, you were playing football, got tackled on the inside of one of your legs while in mid-stride and had your knee pushed outward. This is a perfect example of how an LCL sprain can occur.

If you experience an LCL sprain, you will probably feel immediate pain and may hear a popping or tearing noise. Subsequently, you may find it difficult to walk.

What actually happens during an LCL sprain is a stretching or tearing of the LCL, one of four ligaments that connect bones around the knee joint. The LCL runs down the outside of each knee, connecting the femur (thighbone) to the fibula (one of the bones in your lower leg). The other three ligaments are the anterior cruciate ligament (ACL) in the front, the posterior cruciate ligament (PCL) in the back and the medial collateral ligament (MCL) on the inside. The LCL prevents excessive rotation of the tibia (shinbone) and reinforces side-to-side knee stability.

Injuries to the LCL are most common in contact sports or skiing, but they can occur anywhere, anytime, such as when someone slips on a patch of ice and lands awkwardly on his or her knee. Regardless of how they happen, however, injuries to the LCL often occur in conjunction with injuries to other parts of the knee. Most commonly, an ACL tear accompanies an LCL sprain.

If you suspect damage to your LCL or other knee structures, having your healthcare practitioner thoroughly examine your knee will establish what damage has occurred. Afterward, your healthcare practitioner can effectively care for the damage and promote healing.

A medial collateral ligament (MCL) sprain is a fancy title for a rather common injury, especially in people who play contact sports. If you ever watch football, you’ve probably seen this type of sprain. The quarterback yells, “Hut,” the wide receiver makes his way downfield, receives the pass and gets tackled from the side while his feet are still touching the ground.

Most MCL sprains occur in a similar way, when there’s an external force exerted upon the outside of the knee while the foot is planted on the ground. The initial force then moves from the outside in, so that the real damage occurs on the inner side of the knee, to the MCL. It’s similar to brick-breaking demonstrations in martial arts, where a master piles bricks, hits the pile with great force and crushes the bottom brick to pebbles while the top one remains intact.

While side tackles are a common cause of MCL sprains, the injury doesn’t only occur during athletic activity. Any simple action that twists your knee, such as landing awkwardly from a hop, skip or jump, can cause it. In either case, MCL sprains often occur in conjunction with injuries to other structures of the knee, most commonly with tears of the anterior cruciate ligament (ACL), which sits behind the knee (right behind the kneecap).

If your MCL is sprained, you may hear a popping or tearing noise and usually feel immediate pain, although in some cases it can take 30 minutes or more before the ligament becomes tender. You may also find it hard to walk and, if so, should see your healthcare practitioner immediately, as this could indicate a more serious injury. If the pain is less intense, you should still see your healthcare practitioner as soon as possible, so he or she can determine if other structures in the knee are damaged.

People suffering from patellofemoral pain syndrome (PFPS) have a lopsided tug of war going on in the muscles around their knee. PFPS develops when there’s an imbalance in the strength of muscles that move the patella (kneecap) in its groove as people bend and straighten their leg. The stronger muscle can never quite win the war, but it tugs the patella into an irregular gliding pattern. Like a train that runs off the tracks, the off-track patella still moves, but moves with a grinding friction.

Patients with PFPS can display a variety of symptoms. Usually, they complain of an aching pain in and around the kneecap. The pain tends to worsen after they sit in the same position for a while with their knees flexed, and also after they do physical activities. In the most extreme cases, patients’ knees can give out, which usually happens after they walk down a flight of stairs or increase their level of physical activity.

Active people, however, are not the only ones susceptible to the condition. People with poor posture and people with improper foot mechanics are more at risk. Women must also be careful, as their bodies make them more vulnerable to muscle imbalances than men. With a wider pelvis, women generally have one thigh muscle that’s stronger than the opposing thigh muscle in the same leg. The stronger muscle, usually the outer thigh muscle called the vastus lateralis (VL), pulls harder on the patella than the weaker one, usually the inner thigh muscle called the vastus medialis (VM) and its end portion known as the vastus medialus obliquus (VMO).

Another potential cause of PFPS is flat feet. If you have flat feet, it can cause your tibia (shinbone) to rotate inward, which places extra pressure on the muscles around the knee and possibly exaggerates muscle imbalances and patella grinding.

Fortunately, studies show that 80% of PFPS sufferers respond well to non-invasive treatment, and healthcare practitioners regularly care for patients with a variety of non-invasive techniques. If your healthcare practitioner has diagnosed you with PFPS, he or she will probably combine these non-invasive techniques with rehabilitative exercises to get the patella back on track.

Iliotibial (IT) band syndrome is appropriately also known as runner’s knee. Although runners aren’t exclusively affected, they are by far the most susceptible group.

If you have IT band syndrome, you will probably feel a stabbing pain or burning sensation on the outside of your knee during physical activity. This won’t usually occur at the beginning of physical activity, but rather in the middle.

You have two IT bands, one stretching across the outer side of each leg. Each begins about half way up the outside of the thigh, almost as high as the hip, runs down over the outside of the knee and attaches at the top of the tibia (shinbone). As you bend and straighten your leg, the IT band slides over a bony bump on the outer portion of the knee called the lateral femoral epicondyle.

As you frequently bend and straighten your knee during physical activity, your IT band slides up and down more often over the lateral femoral epicondyle, similar to how a mountain climber’s rope slides over rocks as he or she moves left or right. This causes lots of friction on the IT band, similar to the friction on the climber’s rope. Over time, the friction can cause inflammation of the IT band and the pain associated with IT band syndrome.

That’s why runners, particularly those who cover more than 12 miles (19 kilometers) a week for several months in a row, commonly experience the condition. Besides distance, running downhill is another contributing factor as it increases pressure on the knees. People who have poor foot mechanics while running are also at a greater risk of IT band syndrome, as conditions like over-pronation (excessive inward rolling of the foot) place more stress on the knees.

Not all runners will develop the condition, however, and some people who never run might. Activities that involve rigorous knee movements, like cycling and ballet, as well as a dramatic increase in physical activity can also cause the condition. Studies show that a number of other variables, including improper footwear, structural or functional problems in the legs and feet and duration of activity are also a factor.

If you have IT band syndrome, your healthcare practitioner can help reduce your pain and inflammation. He or she can also use a number of tools and techniques to help you return to activity and can recommend steps to help you prevent the condition from returning. One of those recommendations might be to reduce participation in knee-intensive activities, and until the condition heals you should probably avoid such activities entirely.

Imagine it’s your first time alpine skiing. You come down the hill too fast, hit a bump, catch one ski in the snow and have your leg twisted outward. If you’re unlucky, the ski patrol might wind up taking you the rest of the way down. Compression combined with rotation of the knee joint, whether it’s during a skiing accident, a basketball pivot or something as ordinary as slipping on ice, is one of the most common causes of a meniscal tear, which is a tear in the fibrocartilage that makes up the two menisci in each of your knees.

People who have this injury often feel a dull and constant pain in and around the knee when resting, but a sharp pain when walking or bending the affected leg. If the injury is severe, they may also experience debilitating pain that leaves them unable to walk. There may be some swelling as well, but this may take a few hours after injury before becoming apparent.

If you’ve got all those symptoms but don’t remember experiencing any awkward leg twisting, you could still have a meniscal tear. In fact, healthcare practitioners distinguish between traumatic tears, like those that happen in skiing accidents, and degenerative tears, which most commonly develop as people age.

To understand the difference between the two causes, think of the two menisci (the lateral, or outer meniscus, and the medial, or inner meniscus) working together to form a shock absorber. Traumatic events can overload this shock absorber, causing partial or complete rips. Degenerative changes, on the other hand, simply wear it out.

The latter occurs when the tissue that makes up the menisci dries out, becoming less elastic and less effective at absorbing forces and providing stability. This drying out is a natural aging process that researchers don’t yet fully understand. It can make people susceptible to tears, even when they’re just performing relatively routine, non-stressful activities such as dancing or squatting.

While anyone at any age can suffer a traumatic meniscal tear, young adults appear to be more susceptible because of their more active lifestyles. Degenerative tears, on the other hand, are most common in people in their late 50s or early 60s. Regardless of whether you’re suffering from a degenerative or traumatic tear, however, studies suggest that conservative care is often more effective than surgery for this type of condition.

Surgery may be necessary for severe tears, however. It involves removing part of the meniscus and suturing or scaffolding a graft, possibly a collagen implant, in the knee to promote the growth of new tissue. This surgery is a last resort, and while it generally has good results, non-invasive care should be your first choice as it involves a lesser risk of side effects.

If you suspect a meniscal tear, see your healthcare practitioner as soon as possible regardless of the amount of pain you feel. Tears to the menisci commonly occur with additional injury to surrounding structures, so your healthcare practitioner should perform a thorough examination. Also, because there is poor blood supply to the inner edges of the menisci, tears in this region are infamous for healing poorly. The sooner you seek care, the better.